Primary versus Staged Repair of Isolated Ventricular Septal Defect in Symptomatic Infants Less Than 3 Months of Age

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Abstract Background Interventricular septum defects (VSD) constitute the second most common cardiac anomaly. Large defects carry significant clinical compromise in early infancy. Surgical approach is multifactorial and is not yet a matter of consensus in symptomatic patients below 3 months of age. Methods We reviewed cases who had primary closure or pulmonary artery banding under the age of 3 months for an isolated VSD at our institution from January 2019 to January 2021. Patients were allocated to the palliative and repair groups. Operative mortality, duration of inotropic support, mechanical ventilation and length of Intensive care (ICU) stay were compared. Results Included were 19 patients. Eight patients (42.1%) had pulmonary artery banding, and 11 (57.9%) had definitive repair. No operative mortality was recorded. No difference of statistical significance was noted regarding durations of inotropic support, mechanical ventilation or ICU stay (p = 0.845, p = 0.903, and p = 0.728, respectively). Body surface area was lower in the palliative group (p = 0.027). Conclusion Primary surgical closure of the VSD in symptomatic infants younger than three-month age can be done safely in the current era and eliminates the PAB (pulmonary banding)-related morbidity. However, PAB can be still applied in certain patients who are not candidate for open cardiac surgery.

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